ER or Not: Nosebleed

Interviewer: Some people have been noticing that they're getting more and more nosebleeds as it gets colder and colder along the Wasatch Front. We're going to talk about nosebleeds. When is it serious and when can you take care of it yourself? That's coming up next on The Scope.

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Interviewer: We're with Dr. Troy Madsen, emergency medicine at the University of Utah Hospital. Cold weather, he has told me, has led to a number of patients coming into the E.R. with nosebleeds. Let's talk about that a little bit.

Dr. Madsen: Yeah.

Interviewer: What's going on, first of all? I think we all know but maybe there's something I don't.

Dr. Madsen: No, it's been surprising. I've seen a lot of people lately in the E.R. with nosebleeds, and these have been really, really serious nosebleeds. I'm talking about patients on blood thinners who come in with like a grocery bag full of tissues that are soaked through with blood. I mean, it's awful. We see type a lot of things in the E.R. Nosebleeds can be some of the messiest things we see.

Interviewer: Yeah.

Dr. Madsen: But these are very serious nosebleeds and I think probably a lot of people are having nosebleeds that aren't that serious and aren't coming into the E.R., all as a result of the cold, dry air.

Interviewer: Yeah. I blew my nose the other day and there was some blood in there, should I be concerned about that?

Dr. Madsen: No, generally not.

Interviewer: That's going to happen.

Dr. Madsen: Yeah, it's going to happen and the reason it happens is when the air gets really cold there's just no humidity in the air. It just basically takes all the water that may be in the air, freezes it and then makes it so there's just no humidity whatsoever. So that really dries things out in the nose.
So you've got this part of your nose that basically has all the little blood vessels on it, it's on the septum, it's the middle part of your nose, the cartilage area between your two nostrils. That gets exposed to the dry air, maybe you get a little bit of wind hitting that, it just dries things out, and that's where most nosebleeds happen. So that's why we see a lot of nosebleeds this time of year, cold wind, cold air, no humidity, people are just drying out their nose and get nosebleeds.

Interviewer: And for most people, kind of a minor inconvenience, but if you're on blood thinners, major problem.

Dr. Madsen: Well, the biggest issue, like I said earlier, certainly those that are on blood thinners, like Warfarin, clopidogrel, even aspirin, even if you're taking an aspirin a day we do see some pretty significant nose bleeds in those patients as well. For most people, it's not a big issue; you can usually hold some pressure and it'll go away. But for those people, those are the ones that end up in the E.R.

Interviewer: And we're talking, it won't stop.

Dr. Madsen: Yeah. We're talking it won't stop, they've tried holding pressure for quite a long time at home, and they just can't stop it. A lot of times they require packing in their nose, we have to actually put something up there and leave it in there. Sometimes we even have to call our ear, nose and throat specialist down to see them to try and stop the bleeding.

Interviewer: How long should you put up with the bleeding and it's not stopping before you start getting concerned?

Dr. Madsen: Yeah, so that's a great question because sometimes I do see people in the E.R. who could have avoided an E.R. visit by just trying some things at home and the first thing I would do, is if you do have a nosebleed, hold pressure, squeeze your nostrils down below, where you can feel the bone on your nose, where it's not the bone but where you're holding pressure against that septum, that middle cartilage part of your nose, and hold pressure for 5 minutes. Don't let up. Just leave it there, a lot of people will hold pressure for 15-20 seconds, let up, look again, hold pressure, look again. You don't need to do that. Just hold pressure for 5 minutes.
Now if that doesn't work, the next great thing you can try is a nose spray. And the best nose spray you can use is Afrin. That's what we use in the E.R. and that's the brand name. Now there are generic forms out there but you can just go to the pharmacy, basically you put two squirts of that up the nostril that's bleeding, put it up there and then hold pressure for 15 minutes. Just hold pressure, don't let go.

Look again. If it's still bleeding, two more squirts, hold pressure. Do it again, two more squirts, hold pressure. If after three times of this you're still having bleeding then this very well may not be something that's going to get better at home. You may need to come to the E.R. and get a packing up your nose, something to just put pressure on that bleeding and stop it from bleeding.

So nosebleeds are happening. We are definitely seeing them in the E.R. If you've noticed nosebleeds you're not alone, but if you have a few simple things around the house, a little bottle of Afrin, hold some pressure if it happens, you could potentially avoid a visit to the E.R.

Interviewer: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah Health Sciences Radio.